The Care Quality Commission’s (CQC’s) annual assessment of the state of health and adult social care in England has been published. The State of Care 2022/23 looks at the quality of care over the past year.

According to the regulator, this year has been a turbulent one for health and social care. In addition to the ongoing problem of ‘gridlocked’ care highlighted in last year’s State of Care, this year’s report has found that the cost-of-living crisis is biting harder for the public, staff, and providers – and workforce pressures have escalated. This combination risks leading to unfair care, the CQC has stated – where those who can afford to pay for treatment do so and those who can’t face longer waits and reduced access.

According to the report, adult social care providers are facing increased running costs, including food and electricity, with some struggling to pay their staff a wage in line with inflation, which affects recruitment and retention. This is likely to have an impact on people, the CQC understands, both in the quality of care they receive and in providers’ ability to re-invest in care homes – data from CQC’s Market Oversight scheme shows that care home profitability remains at historically low levels.

In addition, the report has highlighted that local authority budgets have failed to keep pace with rising costs and the increase in the number of people needing care. As local authority funded adult social care places are often less profitable, there is the risk that people who live in more deprived areas, and are more likely to receive local authority funded care, may not be able to get the care they need, the report has summarised.

Some people who pay for their own care at home have had to cut back on visits to support their basic needs, with one homecare provider telling CQC, ‘Due to the cost of living crisis and increased fuel prices, we have had to increase the rates for service users… the outcome was that some people have reduced their care visits to a minimum… this has impacted on their quality of life.’

According to the regulator, access to and quality of mental health care also remains a key area of concern. The report has found that gaps in community care continue to put pressure on mental health inpatient services, with many inpatient services struggling to provide a bed, which in turn leads to people being cared for in inappropriate environments – often in A&E.

One acute trust reported that there had been 42 mental health patients waiting for over 36 hours in its emergency department in one month alone. When people do get a bed in a mental health hospital, the quality of care is often not good enough, the CQC’s report has found. Safety continues to be an area of concern for the regulator, with 40% of providers rated as requires improvement or inadequate for safety.

Finally, the report has identified that recruitment and retention of staff remains one of the biggest challenges for the mental health sector, with the use of bank and agency staff remaining high and almost one in five mental health nursing posts vacant. The CQC has raised concerns that staffing issues in mental health services are leading to the over-use of restrictive practices, including restraint, seclusion, and segregation, and has called on providers to recognise and take steps to address this.

Ian Trenholm, CQC’s Chief Executive, said, ‘The combination of the cost-of-living crisis and workforce challenges risks leading to unfair care, with those who can afford to pay for treatment doing so, and those who can’t facing longer waits and reduced access. And the impact of unresolved industrial action on people can’t be ignored – it’s crucial that both parties work towards an agreement so strikes do not continue into the winter, when disruption will have to be managed alongside increased demand for urgent care and staff sickness.

‘Of course, workforce challenges for the health and social care sector long pre-date the current industrial action. The publication of the NHS Long Term Workforce plan has been a positive step but implementation will be challenging – particularly without a social care workforce strategy to sit alongside it. We continue to call for a national workforce strategy that raises the status of the adult social care workforce and ensures that career progression, pay and rewards attract and retain the right professional staff in the right numbers. It is encouraging that Skills for Care has made this an area of focus.’

Skills for Care’s Chief Executive Officer, Oonagh Smyth, said, ‘Today’s CQC findings reflect many of the trends in our own State of the Adult Social Care Sector and Workforce report, highlighting the ongoing recruitment and retention challenges in both social care and health.

‘With thousands leaving care jobs every year, fixing that leaky bucket remains a priority for us, and we were pleased to see that this report welcomes our recent announcement that we are developing a workforce strategy for adult social care with partners including CQC.

‘CQC’s annual report always offers anyone who wants a skilled and confident adult social care workforce plenty to think about. We look forward to working with CQC on workforce issues so people who draw on care and support have improved access to services when they need them and where they need them.’

To read the State of Care 2022/23, visit the CQC website.

Source – Care Management Matters